Missing Billion report proposes a pathway to close ‘major health gap’ for people with disabilities

Experts say services must be designed to include the one billion people with disabilities globally following ‘shocking’ findings on life expectancy.
Missing Billion report front cover images

People with disabilities are more than twice as likely to die prematurely, taking 10 to 20 years off their life expectancy, according to a new report based on research by experts from the London School of Hygiene & Tropical Medicine.

The report, published by the Missing Billion Initiative and the Clinton Health Access Initiative and released at the World Health Summit in Berlin, calls for health systems to be transformed through intentionally designing services to include the one billion people with disabilities globally.

The report shares a roadmap and new common targets for global health actors on health workforce, affordability, accessible facilities, and empowering people with disabilities, to catalyse essential change by 2030.

Chelsea Clinton, Vice Chair of the Clinton Foundation and the Clinton Health Access Initiative, said: “Right now, we have an enormous opportunity in front of us to reimagine existing health systems in ways that work for everyone, which is why the Clinton Health Access Initiative has partnered with the Missing Billion on this report.

“It is imperative that we build a stronger, more inclusive global health system that is purposefully designed to ensure that everyone on the planet—including the 1 billion children and adults worldwide who are living with disabilities—has access to quality health care.”

The report combines analysis of a data set of 65,000 people with disabilities, systematic reviews of dozens of studies, modelling, and personal perspectives from more than 400 people with disabilities to present a picture of the major gaps in mortality and health outcomes.

It also includes a vision for inclusive health informed by diverse perspectives of people with disabilities. It is a vision where people with disabilities are expected, accepted, and connected within the health system with physical, sensory, attitudinal, cost, and other barriers to quality care dismantled.

Co-author Hannah Kuper, Professor of Epidemiology and Director of the International Centre for Evidence in Disability at the London School of Hygiene & Tropical Medicine, is the Missing Billion Lead on Evidence and Research.

She said: “People with disabilities are being denied their right to healthcare. What we found in this research is truly shocking. There needs to be an overhaul of the way that healthcare is funded and delivered to put an end to this suffering and close the mortality gap.”

The report found that people with disabilities have 2.4-fold higher mortality rates than those without disabilities and are missing 10 to 20 years of life expectancy on average.

A systematic review of 37 studies across 11 countries showed that people with disabilities were 2.8 times more likely to die from COVID-19 than their peers without disabilities globally.

Susannah Rodgers, Paralympic gold medallist in swimming and technical adviser on disability inclusion (UK Foreign, Commonwealth and Development Office), said: “COVID-19 showed the devastating impact of exclusion of people with disabilities in healthcare systems globally. At a time of unprecedented change, world leaders have an opportunity to overhaul and rethink health systems so that equal access to quality healthcare for all can become a reality.”

Dr Ola Abu Alghaib, disability rights activist, United Nations Partnership on the Rights of Persons with Disabilities, said: “The last three years of pandemic have taught us that we can no longer afford less than fully inclusive and accessible health services. The price that persons with disabilities paid losing their life and independence due to poor health systems has to change now.”

The report brings new evidence that on average people with disabilities experience significantly worse health outcomes across Sustainable Development Goal 3 health indicators.

For example, from analysis of middle-income countries disaggregated by disability (separating out people with disabilities from the total population), the researchers found that children under five with disabilities are more likely to experience the most common causes of under-five mortality than children without disabilities. This includes diarrhoea (18% compared to 13% for children with disabilities), fever ( 28% compared to 23%), and acute respiratory infection (34% compared to 27%).

They found lower basic vaccination coverage among children with disabilities, and for those with multiple functional impairments only 44% of children were fully vaccinated.

Adults with disabilities were less likely to have comprehensive knowledge about HIV prevention and transmission (21%) compared to people without disabilities (28%). This gap is particularly large in Sub-Saharan Africa: 23% versus 33%.

In a systematic review of 29 studies from seven countries, women with disabilities were found to be 25% less likely to have been screened for breast cancer and 37% less likely to have been screened for cervical cancer compared to their non-disabled peers.

Funding support for the report came from the Deutsche Gesellschaft für Internationale Zusammenarbeit via the Global Project on Inclusion of Persons with Disabilities with contributions from the Foreign, Commonwealth & Development Office.


The Missing Billion Initiative and Clinton Health Access Initiative: Reimagining health systems that expect, accept and connect 1 billion people with disabilities.


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